Acute hepatitis C during the third trimester of pregnancy

A pregnant woman presented at 32 weeks of amenorrhea with jaundice secondary to acute hepatitis C. Spontaneous delivery took place 3 days later. The infant's serum tested negative for C viral RNA 6 months after delivery. Treatment with high doses of interferon-alpha for a period of 4 weeks was begun 4 days after delivery. Although a virological response was noted at the end of the treatment, the hepatitis relapsed and progressed toward chronicity. Case reports of acute hepatitis C during pregnancy are very rare, as the methods used for the follow-up of pregnant women render the diagnosis of asymptomatic forms difficult. In one case, the acute hepatitis C was severe. The occurrence of acute hepatitis C during pregnancy seems to increase the risk of premature delivery, but not that of vertical transmission. Given the frequency of side effects, it seems preferable not to begin interferon treatment until after delivery.     

Modified pedicled tongue-like skin extension fasciocutaneous flaps for heel reconstruction; a versatile technique

Soft-tissue reconstruction for isolated heel defects represents a challenging surgical dilemma due to tight inelastic tissue and inevitable acute angulations of the fibro-vascular pedicle of local flaps. A modified pedicled flap with a tongue-like skin extension has been designed to eliminate tunnel tightness to avoid traction injury and kinking of the blood vessel. Between 2003 and 2005, eight patients with isolated heel defects were analysed (six men, two women). Their age ranged from 5 to 47 years (median age = 31). Six were traumatic while two were neuropathic. Reversed sural (n = 4), medial planter (n = 3) and one dorsalis pedis artery fasciocutaneous flap were used. The average follow-up period was 1 year during which the flaps were monitored for venous congestion, ischemia, superficial epidermolysis and partial or total flap loss. Only one modified pedicle flap showed mild venous congestion; on the other hand, no other ischemic events such as superficial epidermolysis or flap loss were experienced. The modified tongue-like process extension is considered a valuable tool to increase the versatility of these flaps.     

Mitochondrial DNA deletions parallel age-linked decline in rat sensory nerve function.

In rats, the function of sensory nerves in the hind limb declines significantly with age. Normally aging rats and rats treated neonatally with capsaicin were studied here. Quantification of vascular response and substance P in young (3 months) and old (24 months) rats showed additive effects of age and capsaicin treatment. The levels in dorsal root ganglion of a particular deletion in mitochondrial DNA (mtDNA(4834)) were about 300-fold higher in old compared to young rats. Capsaicin treatment had no significant effect on mtDNA(4834) abundance. Dorsal root ganglia of old (but not young) rats were found to contain a spectrum of multiple deletions. The abundance of mtDNA(4834) in dorsal root ganglia from individual rats correlated strongly with their decline in vascular function, even where vascular responses were systematically depressed due to prior capsaicin treatment. One possibility is that mitochondrial DNA mutations directly lead to functional decline at mitochondrial and tissue levels. Alternatively, loss of mitochondrial DNA integrity and physiological decline may be consequences of the same factor, such as oxidative stress.     

Comparison of the Levogyre and Dextro-Levogyre Forms of Leucovorin in a Phase III Trial of Bimonthly LV5FU2 Versus Monthly 5-Fluorouracil and High-Dose Leucovorin for Patients With Stage II and III Colon Cancer (GERCOR C96.1)

BackgroundThese analyses compare the safety and efficacy of 2 forms (levogyre [L] and dextro-levogyre [DL]) of leucovorin (LV) when used with 5-fluorouracil (5-FU) for the adjuvant treatment of patients with stage II and III colon cancer.Materials and MethodsThe analysis used primary efficacy and safety data of a phase III trial comparing monthly 5-FU/LV or bimonthly LV5FU2 (LV 200 mg/m² intravenously over 2 hours followed by 5-FU 400 mg/m² bolus and then 600 mg/m² continuous intravenous infusion over 22 hours, days 1 and 2, every 2 weeks). In both regimens, depending on the choice made by each center, patients received either DL-LV (200 mg/m²) or L-LV (100 mg/m²).ResultsL-LV and DL-LV were administered respectively to 60% (n = 519) and 40% (n = 357) of the patients. Important prognostic characteristics were well balanced between the 2 groups. The proportion of any grade 3/4 toxicity was 20% in the L-LV group and 17% in the DL-LV group. There was no statistical difference in terms of toxicity between the 2 groups. The median follow-up time was 6.1 years. There were no statistically significant differences between L-LV and DL-LV in terms of either disease-free survival (66.7% vs. 67.2%; hazard ratio [HR], 1.03; 95% CI, 0.82-1.31; P = .78) or overall survival (78.2% vs. 74.5%; HR, 1.28; 95% CI, 0.97-1.69; P = .078).ConclusionThis study supports the use of either DL (200 mg/m²) or L (100 mg/m²) LV in association with 5-FU as adjuvant treatment of patients with colon cancer.     

Pediatric cervical spine instability

Cervical spine instability in children is rare but not exceptional and may be due to many factors. Although it mostly occurs at the upper cervical spine, all vertebrae from the occiput to T1 may be involved. It may be acute or chronic, occurring secondary to trauma or due to congenital anomaly, skeletal or metabolic dystrophy or rheumatoid arthritis. It can be isolated or associated with other musculoskeletal or visceral anomalies. A thorough knowledge of embryology, anatomy, physiology and physiopathology of the cervical spine in children is essential to avoid pitfalls, recognize normal variants and identify children at risk of developing cervical spine instability and undertake the appropriate treatment.